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Limited long-term reproducibility of white coat effect in general practice (Gubbio, Italy)

Xavier HUMBERT

Office white-coat effect tail (OWCET), the waning of blood pressure after its wax during office visit, predicted long-term major fatal and non-fatal cardiovascular events. Data on the long-term reproducibility of OWCET are scare.The aim was to examine the long-term reproducibility of OWCET in the Gubbio residential population study (Gubbio, Italy) after approximately 5.8 years follow-up.To determine the presence of OWCET, three measures of blood pressure separated by one minute each was involved . If the first measure is at least 10 mmHg greater than the third measure, we consider a presence of OWCET. We used a cohort study realised in Gubbio, an Italian city. It started in 1983 and contains a first serie of data collection, during appointments, as well as a second one between the years 1989-1992. Studying the reproductibility of OWCET boils down to evaluating the existence of a dependance between the presence/absence of a OWCET during the first appointment and the presence/absence of a OWCET during the second appointment in the same individual. In order to measure the strength of the reproductibility of OWCET, we will use the Cohen's kappa statistic.The raw rate of reproductibility in the 1 300 individuals sample is 72.69%. : 907 (69.77%) individuals did not present a OWCET during either appointments ; 38 (2.92%) individuals presented a OWCET during both appointments ; 148 (11.38%) individuals presented a OWCET during the first appointment but not the second one and 207 (15.92%) individuals presented a OWCET during the second appointment but not the first one. For the sample of 1 300 individuals of age between 35 and 74, the kappa statistic is equal to 0.016 (95%CI: -0.039;0.071).In our knowledge, it is the first time that long-term reproducibility of OWCET was tested. Others BP concept reproducibility was studied in the past with the same poor reproducibility.OWCET display poor reproducibility over time. This should be taken into account in studies assessing the long-term prognostic value of these conditions based on only one set of BP measurements, in particular in primary care.